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Abstract—This paper highlights best practices of
technological influenced e-government using ICT, emerging
mobile and web 2-0 technology for the effective health Care &
disease management system. Modern technology has given a
whole new dimension to the concept of good governance, thus
embarking a strong and effective influence on citizens and
cultural trends. Authors have investigated successful case
studies, which are taken from existing practice of e-
government health care projects within Pakistan.
Pakistan was hit by the epidemic of dengue, affecting over
350,000 people in 2010. Due to the unprecedented scale of
epidemic, the basic health infrastructure was not ready to
address the issue. However by 2012 a monitoring mechanism
was devised as an e-Govt health care activity, to log all field
activities related to prevention/eradication of the disease. The
project focused mobile reporting using android phones, EDGE
services, and Google maps. 650 smart phones users reported
43,000 activities. The information received was extrapolated to
bring all stakeholders of anti-dengue campaign on a single
platform and DIMS (Dengue Information Management System)
was conceived. Features of DIMS include: A central
dashboard to view and dispose of complaints on real-time
coming in from the Helpline and Hospitals e-CRS (Electronic
Complaint Routing System). 2 Vector Surveillance System
for tracking and reporting all indoor / outdoor larvaciding
activities. 3 A Disease Reporting System to manage the
clinical and lab diagnosis records of dengue affected patients.
Utilization of this system has resulted in 0 % deaths
reported due to dengue in the past 1.5 years. Careful
investigation of step by step usage, reporting to DMIS with
Android phone and working behavior of ICT infrastructure
are elaborated in this research.
Index Terms—E-Govt., ICT, web 2.0, cellular technology,
health.
I. INTRODUCTION
One of the major concerns of any Government, in favor
of citizen’s welfare is health care .However, health sciences
over the last couple of decades depend more on IT centric
initiatives to consolidate information of masses for
meaningful usage and informed decision making. One of the
major e-Govt Health Initiative has been witnessed working
Manuscript receivedMay 20, 2013; revised July 28, 2013.
F. Zafar is with the Govt. College University, Lahore, Pakistan (e-mail:
R. Saifullah Hassan is with the University of Engineering and
Technology, Lahore, Pakistan (e-mail: [email protected]).
Z. Mahmood is with the University of Derby, UK & North West
University, Unit of Business Mathematics and Informatics, Potchefstroom,
South Africa (e-mail: [email protected]).
effectively in Pakistan to deal with Dengue epidemic.
Pakistan especially Punjab has been hit by vector-borne
disease of Dengue reporting 26,270 effected cases. Non
availability of historical data in an organized manner
represents challenge for early detection of any future
outbreaks thus limiting the capability of government for
early preparedness and emergency response. However in
developing country like Pakistan, e-Govt has played vital
role for health care using emerging Cellular and web 2.0
technologies involving smart phones and geo tagging in
order to overcome the epidemic of Dengue .This practice
was initiated within Punjab, which was reported the largest
epidemic of dengue worldwide. Dengue, which is a
mosquito –borne viral infection is conventionally referred as
break bone fever. It is an infectious or transmittable tropical
disease caused by the dengue virus [1]. A mild dengue
victim develop symptoms as fever, head ache, muscle and
joint pains and in severe cases it develops life threatening
Dengue High Fever (DHF), which exhibits bleeding, low
levels of blood platelets and blood plasma leakage casing
risk of death within 5-7 working days. Dengue epidemic has
touched the alarming situation globally with thousands of
fatalities world-wide since 2001.
A. Medication
There is no medication and available vaccine in market
which claims to reduce the risk of dengue virus.
B. Prevention
Scientists and experts have agreed that the prevention is
sought by reducing the habitat and the number of
mosquitoes and limiting exposures to mosquito bites from
dawn to dusk [2].
C. Effective E-Govt Role and Solution
Disease surveillance and reporting MIS system, Geo
tagging of snapshots taken of Dengue larva cites by field
officers, digital centralized Dashboards managing all
information , Location tracking of Patients infectious with
disease and timely availability of blood donor for DHF
patients using e-blood line, Training and use of state of the
arts web 2.0 services and Smart phones with Android
application, Custom built mobile application development
for extremely response Citizen–Govt linkage for Dengue
Activity Tracing and complaints registration against any
District Health Officers and other e-Govt stakeholder who
does not co-operate with citizens regarding health issues,
and DSIM with GIS maps along with centralize dash boards
to manage and analyze all information in order to provide
F. Zafar, R. Saifullah Hassan, and Z. Mahmood
Effective Use of ICT and Emerging Cellular
Technologies for Health Care: E-Govt Reshaping
Governance into Good Governance
DOI: 10.7763/JOEBM.2014.V2.131
1)
)
)
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Journal of Economics, Business and Management, Vol. 2, No. 3, August 2014
rapid strategic solution.
II. LITERATURE REVIEW
The first suspected dengue-like epidemics emerged in the
Americas in the 1600s, and by the 1800s, were common in
port cities across the region, from the Caribbean to South
America. In 1934 Dengue impacted about 10% of the
population and it spread through Florida and South Georgia
[3], [4]. The first mosquito eradication effort was in 1901 in
Cuba, and by the mid-20th century, only one dengue virus
strain (DENV-2, genotype V) seemed to be in circulation.
The number of reported dengue cases increased
considerably in the early 1980s; one of the worst outbreaks
of that period in Cuba, during 1981 resulted in 344,000
cases.
III. DENGUE STATISTICS AROUND THE WORLD
The World Health Organization estimates that more than
2.5–3 billion people, or more than 40 percent of the world’s
population, are now at risk of being infected with dengue
[5].
The Most targeted regions of the disease are SE Asia [6]
and the Western Pacific (Fig. 1), but within past few years, a
rising trend is witnessed in South America and the
Caribbean [3]. Average annual number of DF/DHF cases
reported to World Health Organization along an average
annual number of countries reporting dengue is shown in fig
1 below [1]. By 2010, Dengue came up as a severe
transmissible disease for more than half of the world’s
population , and thereby in 2013, the statistics still revealed
the critical condition of the severity of the issue and the
dengue plasmodium in Latin America and South East
Asia[3], [7]. The threat of a possible outbreak of dengue
fever now exists in Europe and local transmission of dengue
was reported for the first time in France [8] and Croatia [9]
in 2010.
Fig. 1. Dengue, countries or areas at risk, 2011.
A recent (2012) outbreak of dengue on Madeira Islands
of Portugal has resulted in over 1800 cases [10]. An
estimated 500 000 people with severe dengue require
hospitalization each year, a large proportion of whom are
children. About 2.5% of those affected die. In the past few
years, cases of dengue have popped up in Texas, Florida,
France, and Croatia. Of the 500,000 cases of severe dengue
requiring hospitalization and the roughly 24,000 deaths they
cause each year [11], most are in children, according to the
WHO [5]. A recent study estimated that there were more
people at risk of dengue infection calculating that up to 3.97
billion people are at risk in 128 countries [12] (See Fig 1).
Approximately 50 million infections occur annually with
500 000 cases of DHF (Fig. 2).
It is also estimated that there are 22,000 deaths per year,
and mainly among children. Only in India, 37 million
dengue cases have been reported with 227 500
hospitalizations [2], [6]. Health authorities in Brazil have
reported more than 200,000 dengue infected people within
first seven weeks of 2013 as compared with 70,000 in the
same period last year, thus, indicating a steep rise in
confirmed cases.
Fig. 2. DF /DHF cases reported to WHO [2].
A. WHO Strategy Report Targets Dengue
WHO has highlighted the increased stress and target of
Dengue fever in its recent report (Fig 3), Global Strategy for
Dengue Prevention and Control, has already set a goal of
cutting deaths caused by dengue by 50% along with 25%
reduction in effected cases over the next 8 years.
Fig. 3. Average number of dengue cases in highly endemic countries.
B. Dengue in America
From the beginning of 2013 up to epidemiological week
(EW) 21 in the Region of the America, hundreds of
thousands dengue cases have been reported [1].
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Journal of Economics, Business and Management, Vol. 2, No. 3, August 2014
TABLE I: DENGUE CASES REPORTED WORLD WIDE-2012
Registered Cases Severe Dengue Death
868,653 8,406 346
The escalation of dengue fever incidence in Latin
America – with more than 1.1 million cases reported in
2012 poses a serious public health threat. Table I shows the
ratio of dengue spread in world and in 2012. Fig. 4 shows
Dengue outbreaks in America within 2008 until 2010 and it
is clearly shown in Fig. 5 that 1.1 million cases have been
reported in USA only in 2012 [3].
Fig. 4. Dengue outbreaks in the Americas, 2008-2010 [13].
Fig. 5. Reported dengue cases in the Americas-2012 [13].
C. Dengue in Germany
Given are the statistics representing dengue attacking
Germany from 2001 to 2010 where it is observed that in
2007 and onward dengue cases were reported double and
three times in numbers as reported previously [14] (See
Table II).
TABLE II: DENGUE CASES REPORTED FROM 2001 TO 2010
Year Number of Recorded Cases
2001 60
2002 213
2003 131
2004 121
2005 144
2006 175
2007 264
2008 273
2009 298
2010 387
D. Dengue in China
A total of 655,324 cases were reported from 1978 to 2008,
resulting in 610 deaths [15]. However since 1990s, dengue
epidemics have spread gradually from Guangdong, Hainan,
and Guangxi provinces in the southern coastal regions to the
relatively northern and western regions including Fujian,
Zhejiang, and Yunnan provinces [16]. Latest Statistics show
12,435 cases have been reported in 2013 until July (See
Table III).
TABLE III: DENGUE CASES AND DEATH COUNT-2013
Distribution Reported Cases Deaths
China 12,435 47
ILOILO City 1,805 14
Cabatuan 219 4
E. Dengue in SA
Only within South Asia until June 2013, a total of
145,496 cases have been reported for dengue causing 528
deaths [17], [18] (See Table IV).
TABLE IV: DENGUE CASUALTIES IN SA-2013
Country Reported
Cases
Fatalities
Singapore 13,047 05
Malaysia 10,400 22
Sri Lanka 16,000 29
Myanmar 6,448 13
India 50,000 242
Indonesia 3,119 14
Maldives 4,482 10
Philippines 42,000 193
However recent research statistics show an interesting
figure coming out of Pakistan within SA. Table V below
shows that in the year 2010, a total of 26270 cases were
reported, whereas in 2011 a total of 21000 cases were
reported ending up with 512 fatalities, which gradually
decreased down to reported cases being 894 in the year
2012 causing 12 deaths and in 2013, only 11 cases are
reported with 0% fatality rate [19].
TABLE V: DENGUE STATISTICS IN PUNJAB-PAKISTAN [19]
Year Reported Cases Fatalities
2013 11 0
2012 894 12
2011 21,000 512
2010 26,270 256
This dramatic reduction in dengue victims and death
counts is only possible due to few initiates which were taken
by Government under its e-government sector [20]. The
next section describes DMIS which was a disaster
management and health care system planned, developed and
successfully launched by Punjab Government [21]. Beyond
political and economic factors, the dengue problem is
exacerbated by climatic factors such as heavy rainfall and
monsoon season .Since dengue fever is said to be a climate-
sensitive disease that becomes more pronounced when hard
rains hit and thus during monsoon from June-August its
more likely to hit Pakistan and similarly in any part of the
world. Research and studies have shown a clear correlation
between incidence of dengue fever and heavy rainfall in
tropical and subtropical regions. Heavy rainfall causes
standing water, and encourages people to keep more water
around the home to deal with future shortages–both of
which create more breeding areas for the Aedes mosquitoes
that transmit dengue.
This is only the virtue of DMIS that dengue is controlled
100% which is a big success of utilizing proper ICT as
remedial measure for health care facilitation. As according
to WHO , there is no specific treatment for dengue/ severe
dengue, but early detection and access to proper medical
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care lowers fatality rates below 1% [22], [23]. Dengue
prevention and control solely depends on effective vector
control measures.
IV. USE OF EMERGING CELLULAR, WEB 2.0 TECHNOLOGY
IN HEALTH CARE
In February 2012, responding to the thousands of the
cases being reported already in the preceding years, the
Punjab government initiated monitoring mechanism, which
was devised to log all field activities related to
prevention/eradication of the disease. The system as devised
back then is still operational and entomologists/field officers
report activities on regular basis. The tasks taken by the
governmental field officers extends from awareness to
community, removal of debris, identification of ponding,
larviciding and IRS (spraying) at premises of confirmed
patients [20].
The project focuses on reporting using cellular and web
2.0 technologies, taking e-measure to combat the disease in
Pakistan. Each member in the field is provided with an
android smartphone who reports there and then using edge
services. Given are the details of project initiated and
successfully launched by e-Govt within Pakistan to
overcome dengue.
V. DIMS-DENGUE INFORMATION MANAGEMENT SYSTEM
DIMS is a central dashboard for all stakeholders to view
and dispose of complaints on real-time coming in from the
Helpline and Hospitals e-CRS (Electronic Complaint
Routing System). It is an efficient Vector Surveillance
System for track/report of larvaciding activities.
Furthermore a Disease Reporting System is embedded as
key feature in order to manage the clinical and lab diagnosis
records of dengue affected patients.
Value Propositions
Real time coordination amongst departments.
Used for early outbreak detection for epidemics with
the help of geographically mapping of patient’s data.
An avenue for citizens to register the complaints and
comments on the government department's
performance.
Real time control of management and efficiency of
concerned departments through centralized dashboard.
A contact center platform used to respond in
emergencies e.g. track spurious PIC drug issue, this
system was used to guide the patients and generate
required MIS.
Campaign management tool, e.g. It is also being used
to register complaints regarding the ongoing Polio
campaign and monitor the same via GIS maps.
Platform for disease reporting by public, government
hospitals and private health practitioners.
DIMS is divided in 4 sub Projects, which are deployed
with highest level of cellular technology using smart phones.
The interface is provided and monitored via smart web 2.0
systems at client /server ends. However it is notable that
these sub projects have the capacity to operate and execute
their functionality independently as well. The projects are
named as:
Dengue Activity Tracking System
Geo-Tagged e-Blood Line and Blood / Donor
inventory system
Punjab Health Line
Disease Surveillance System
VI. DENGUE ACTIVITY TRACKING SYSTEM
This is first phase of DMIS which works independently
as well as in conjunction with other sub projects.
Procedure
The user takes a geo-tagged photograph while performing
the designated task. Field officers are also mandated to
identify breeding hotspots and remove them accordingly,
two separate photographs are submitted highlighting before
and after activities clearly [24]. Data stream as submitted
via smart phones gets plotted onto Google maps. Fig 6
shows an activity for the removal of waste material and
debris where dengue larvae are prone to breed.
Fig. 6. Geo Tagged Picture send and reception on DMIS web 2.0 Portal
[24].
Data stream as submitted via smart phones gets plotted
onto Google maps. Fig. 7 shows dengue activity tracking
system within Lahore on this Dengue Activity Tracking
portal and is highlighted in red dots across various regions
of Lahore city. The report and plotted disease can be seen
on day to day to monthly scale basis for 1 year at a time.
Fig. 7. Dengue activity tracking system portal for Lahore [21].
A record is generated at the end of e-Govt health portal
and given is an activity graph which shows number of
picture count taken for purpose of reporting over the portal
and it shows that more than 88,000 activities were lodged
and prompt action was taken by e-Govt DMIS [20](See Fig
8 ).
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Fig. 8. Yearly activity log of geo tagged pictures [24].
VII. GEO TAGGED E-BLOOD LINE AND BLOOD /DONOR
INVENTORY SYSTEM
E-Blood line is an initiative taken by the government in
order to connect the right donor with needful patient at the
right time. The establishment of a blood inventory system
and creation of a blood donor database with geographical
tagging and cell phone ID pivoted over Call Centre services
is established to deal with dengue epidemic, so as to
mobilize and organize willing donors in order to cope with
blood shortage[24]. Since Dengue fever results in loss of
blood platelets and white blood cells, therefore in severe
conditions, to avoid possible fatality, patients are required to
get infused with healthy blood to overcome deficiency in
White Blood Cells. Government data and statistics s
describes more than 600,000 blood donations per year in
Pakistan [19].
Procedure
A distinct feature of this project is that, patient’s family
cannot contact PBL donors directly. Only blood banks,
which meet the project requirements, can launch blood
requisitions on PBL online portal. Call Center Agents
(CCAs) contact the active donors from that particular area
and direct the willing donors to the blood bank which raised
the blood requisition. In this way a buffer is created between
donors and patients, so that either party does not face any
undue pressure. A centralized PBL online portal enables
resource sharing between blood banks for better crisis
management, which has drastically reduce the wastage of
blood bags.
VIII. PUNJAB HEALTH LINE-A CALL CENTRE
DMIS takes logs and records from health line call center
as well. After being victimized for Dengue over 350,000
people in 2010, Government formulated e-health line to take
immediate measures with needed solution [21]. This Call
Center was established in a record time of 48 hours for
counseling the citizens 24/7 and was manned by 150 doctors
taking calls on a toll free helpline – thus, The Punjab e-
Health Line came into being and was managed under
Punjab Information Technology Board[19], [20]. The
objectives of this Call Center establishment that were added
over period of time included:
Patient counseling
Preventive measures to the citizens
Advise on treatment protocol to health practitioners
Logging of Fumigation Service requests
Solid Waste Disposal requests
WASA/ Sanitation related requests
Complaints (Over charging by laboratories, Private
hospitals, Govt. hospitals, etc.)
The information received at the Call Centre was further
extrapolated to bring all stakeholders of anti-dengue
campaign on a single platform and send to DIMS (Dengue
Information Management System).
IX. DISEASE SURVEILLANCE SYSTEM
Procedure
To start with, Teaching Hospitals, Tehsil Headquarters
(THQs) and District Headquarters (DHQs) are manned with
dedicated data entry operators, who are responsible to report
cases as per the predefined templates. The data entry
interface is exposed to Government Hospitals via secured
usernames and passwords. Disease wheels are planned to be
provided to respective Health Officers and District In
charges, who report disease cases via SMS [21].
DSS as envisioned uses SatScan and Early Aberration
Reporting System (EARS) as used by Centre of Disease
Control and Prevention in USA[19]. Targeted to ensure
emergency response and preparedness, the system connects
all stakeholders to respond to any alarming situation in a
coordinated manner. The project features of DSS are:
Case detection, case registration, case confirmation
and case supervision.
Data Analysis and Interpretation.
Representation on GIS Maps.
Timely escalation and Intimations.
District/Tehsil and UC wise disease widespread trends.
Dispersion of disease over time, space or space and
time.
Time periodic disease surveillance for early detection
of disease outbreaks
The project is live in four hospitals named DHQ
Shiekhupura, THQ Muridke, Children Hospital and Mayo
Hospital where results are getting compiled for finalization
of implementation strategy throughout Punjab with more
than 25 departments involved and 550+ users reporting [20].
X. CONCLUSION
DIMS has proven to be an effective ICT project, initiated
by e-Govt sector within country .Utilization of this system
has effectively resulted in 0 % deaths reported due to
dengue in the past 1.5 years within the same region .A
country which is globally worst effected target of dengue
with 35000 dengue patients has achieved Nil death count
and dramatically reduced number of 11 disease infected
cases in the year 2013. Role of government in terms of
public welfare and health policies has been reshaped with
utilization of emerging tools in cellular communication.
DIMS, along with e-health facilities including Disease
Surveillance System, Geo-Tagged e-Blood Line and
Blood/Donor inventory system, Punjab Health Line
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Journal of Economics, Business and Management, Vol. 2, No. 3, August 2014
practices by e-Govt are directly associated with common
citizen in terms of cure or fearing risk of fatality .This ICT
infrastructure can help any other country facing dengue
epidemic to overcome and effectively control the situation.
In addition, the same projects can help to be utilized in
surveillance and monitoring of other fatal diseases like
measles etc. This E-Govt health care facilitation however
has attained a bench mark of confidence over the political
establishment and it was evident in the recent elections of
2013, that the governance act and political establishment,
who has initiated these e-health activities and projects was
heavily appreciated by public, and this and citizen-to-
government trust has taken new shape, by earning vote of
trust by common citizens and resulting overall
establishment of improved Govt-to-Citizen and citizen–to
Govt relationship as seen in the 2013 election results.
Eventually health care policy and tools by e-government has
changed impression of government into and good
governance within Pakistan.
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Fareeha Zafar was born in 1978 in Lahore,
Pakistan. She has received PhD in computer
Sciences in particular Mobile Cellular networks
from University of Derby-United Kingdom in
2009. She also has MBA-HRM, M.Phil.
Comp.Sc–UK, M.Sc. Software Engineering
Pakistan and M,Sc Networks from Pakistan.
Fareeha Zafar also holds CCNA, CCNA, CCIT, C-Voice and CCIE
certifications. She is senior faculty for IT and Business over 13 years
among which she taught 6years in UK .At present she is employed
with HEC Pakistan and deputed as Assistant Professor at Govt.
College university Lahore, Pakistan. Fareeha is Research Head for
mobile & Communication advancements as well as for e-Practices for
Business Management & ICT for e-Govt. She is also In charge of
PhD program at Govt. College university Lahore.
Dr. Zafar has over 24 research papers and she is executive Editor
of Science International Journal- Lahore. She is reviewer and member
editorial board of ABSRC, WASET, CISCO, ACM and multiple
journals and books. She is associate to multiple foreign Universities
for ICT & business Schools in Europe, Asia, and Africa. Dr. Zafar’s
research includes e-Govt practices & polices, Cloud Computing,
Wireless Sensor Networks, Mobile Communications, LTE, Mobile
RF and Tele medicine.
Rana Saifullah Hassan was born in 1991 in
Lahore, Pakistan. He is perusing his MS at
Institute of Business and Management,
University of Engineering and Technology,
Lahore. He has received his B.Sc. in Business
Accounting & Finance from GC University
Lahore, Pakistan. He is an enthusiastic Research
associate for e-Practices for Business
Management and ICT for e-Govt. He is closely
working in group with Fareeha Zafar managing
domains of e-practices in particular e-Govt. Rana has 4 publications
in reputed Journals and is author for multiple chapters on e-Govt
within IGI book series and is active journalist with leading
newspapers within Pakistan. Rana has served multiple organizations
in capacity building, Accounting and Human Resource Management.
Mr. Hassans research interest revolves around e-governance,
practical projects and solution for e-Govt issues, Social media,
emerging technologies, Web & ICT at business, Human Resource
Management and e-Banking.
Zaigham Mahmood is a professor who has an
M. Sc in Computer Sciences from Pakistan
where he was born, and after which he received
PhD in Modeling of Phase Equilibrium from
UK. His experience in education sector spans
over three decades. He is currently at Univ of
Derby UK as well as with the Unit of Business
Mathematics and Informatics North West Univ
Potchefstroom S. Africa where he is a Professor Extraordinaire. He is
also a technology consultant at Debesis Education UK.
Dr. Mahmood has more than 100 publications in leading journals and
is an author of 10 books on various topics spanning from cloud
computing to e-government .He is Editor-in-Chief of Journal of E-
Governments Studies and Best Practices as well as Editor-in-Chief of
book Series on E-Government, Digital Divide and Regional
Development with IGI Global. His research interests include e-Govt,
Project Management and Cloud Computing.
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